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The management of patient's mechanical ventilation, in acute respiratory failure and / or adult respiratory distress syndrome in developing countries is generally done by anesthesiologist. Even in developed counties, patients with acute respiratory failure and particularly adult respiratory distress syndrome have a very high mortality rate. Extracorporeal membrane orygenation ( ECMO) is an innovation of high technology in the intensive care medicine which emerged nvo decades ago, In certain centers in several develctped countries, ECMO for acute respiratory failure is used as a rescue therapy or as an altemative therapy at a certain predicted mortality rate. In fact, in neonatal respiratory failure in the United States, ECMO is considered as a standard therapy. IJnfortunately, the result of ECMO is dffirent at dffirent age groups. The best results is in neonates, i.e, 70-90Vo surtival rote, while for older ckiWren and adults the mortality rate is 45-55Vo for patients with predicted mortality rate around 80Vo with mechanical ventilation. Would it be possible 1o start ECMO therapy in developing countries? ECMO has been unquestionably swccessful in treating a large nurnber af term infants with respiratory failure, but ECMO is very labor intensiye. The cost for ECMO is very high, it is about tv,ice as kiglt as standard intensive care treatment. Taking into considerations the cost benefit analysis and cost effictive analysis ECMO would be better carried out in developing countries only at certain hospitals with enough bypass or open heart surgery expertence (tr-2 selected centers), and is best done ontry in neonatal respiratory failure. Keyword.s: ECMO, Developing countries, Cost, Neonates

Extracorporeal membrane oxygenation (ECMO): New technology or just a new tool for developing countries?